HomeMy WebLinkAboutHeating Permit 95-0096 1. Pink - File
p F PRIp�, `�, '� " TYPE OF STRUCTURE 3. Yellow - Convacmr
., � ������ilQR LAKE
� Cre�ek Av. S.E. �' �
u rn Permit No. Single Family � Two-Family Mufti-Family
, , ���, MN 55372
E T11�lC�AeP_LLC�N / PERMIT �mmercial Industrial Public Other
�! �1,�. A
Date S`3 ���� fiB�# �Jr��— O D l-0 �OB VALUATION FEE
Site Address _ 5200 ,(7 � �� � �' � $� ' $�'�� 2% of job value, min. $20.00
��1� ir r u� 2io �2. L.1�-(GF
Lot � Block � Addftion �/�trsQ�Q./ �Lr�,lCa/ 0�' u�co� `•�✓ $1'�� �$�0,000 $20.00 for the first $1,000 plus $1.25 for each additionai
$100.00 or fraction thereof to and including $10,000.
Owner'sName Au7n� �.D�tFP ,�iP�TS 1 $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address 5��� ��D iT /�r v�'/1 Kd' v�E tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor
Address $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone #
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make 8� Mode! t�i'�`G�/' i� TYPE OF SYSTEM Addft�nal inspections will be billed at $25.00 e�h.
Warm Air Plants
Model Size liGY?OG'�✓ Gravity House Heating Test Record must be submitted w8h building �ermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditioning
Fuel Flue Size Vent. System HEAT CALGULATIONS REQUIRED with number of supply artd return openings listed
HEATING OR POWER PLANT Pgr room with CFM's per opening. New structures or additions send floor plan with sup-
Supply Openings ply and teturn locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Retum Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input Output Speciat Devices
City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FlNAL) - CALL CITY HALL
Cfm.
447-4230.
TYPE OF WORK I hereby apply tor mechanical systems permit and 1 acknowledge that ihe information
Atterations _�_ Replacemerrt New Construction above is complete and accurate; that the work will be in conformance with the ordi-
nances and oodes of the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date �� �' q s does not become a per ' until signed by the BUILDING OFFICIAL; that the woric wi(t be
E � �� $� g � , �� '/ '/ in with the roved pla 'n ihe case of aA work which requires review and
Building Permit # �'f ro lans.
� `� HEATING PERMIT FEE $
STATE SURCHARGE $ .50 licant's Sign ure Date
TOTAL PERMIT FEES $ .�7 U Receipt #�9�`'7
Building ' ial's Signature Date